More on Burns….

Having just returned from 2 weeks working in the eastern Democratic Republic of Congo- I am again humbled and saddened by the devastating effects of burn injuries.

Some patient examples:

older child with contracture of axilla and antecubital fossa

adult with neck and face keloid/contractures

As mentioned in my prior blog posting- prevention is key.

Prevention of the burn injury in the first place

Many burn injuries, especially those involving children are due to indoor cooking over an open fire. Although inefficient in terms of use of natural resources (wood,coal) this way of preparing food is a major cause of burn injuries. In addition, the indoor air pollution created is a significant contributor to pulmonary illness worldwide. A number of initiatives are ongoing to create and distribute safer and more effective ways to cook and thereby prevent these debilitating conditions. The largest and most ambitious is the Global Alliance for Clean Cookstoves: http://cleancookstoves.org

Prevention of contractures in patients who have sustained burn injuries

As mentioned in my prior post, it is far easier to prevent the contracture than to treat a longstanding joint contracture- as often it is more than just a “skin” problem. Longstanding contractures often lead to joint irregularities/arthritis, as well as tendon and ligament abnormalities, which can make normal function impossible despite operative intervention.

Splints, early skin grafting, regular physical therapy during the healing process are the keys. This does not require high tech equipment- have the patient squeeze a rubber ball or use cloth to create a sling the patient can pull against. The goal is to keep joints moving and supple- to try to prevent joint contractures and thereby prevent lifelong disability.